Tag Archives: Medical Technologies

1. How did the idea for Life in Crisis: The Ethical Journey of Doctors Without Borders came about? What inspired you?

I had friends who had worked for Médecins Sans Frontières (MSF) so I’d heard about them for some time. I thought it would be an interesting subject in part because the phrase sans frontières — “without borders” — later became a tagline for globalization. Historically this is the group that popularized that expression, if with rather different aims than to open markets. The organization’s core movement in France began to engage a “borderless” world of sorts in the early 1970’s, imagining that doctors should be able to reach patients anywhere, overcoming all barriers. I wanted to look at what it means to practice medicine with this global ambition in mind: How to take biomedicine (i.e. the sort of healing taught in medical schools) and move it anywhere in the world and try to make it work.

I’d also just finished my first book and started to teach at UNC. I was meeting a lot of undergraduates who wanted to do something good in the world — to make a difference, to live a meaningful life. Whether they were actively thinking about it or not, many of them were likely going to work in the world of NGOs, nonprofits, etc. So I wanted to look at such engagement once you put it in practice, into motion. What happens when your great idea actually takes off?

While there have been lots of things written about MSF in French, at the time there was little in English, even at a journalistic level. There was not a great deal of analysis in an anthropological sense (although now there is much more). Over the last dozen years, global health has emerged as a key term. Even the School of Public Health changed its name! Looking at MSF is a way to try and think about global health, or one version of it in practice. To see it in motion over time, to see what it means to try to be global in the most literal sense of direct cross-border mobility as opposed to having “international” relationships in the nation-to-nation sense. Historically, one of MSF’s claims (which is exaggerated but has a kernel of truth) is that the group can go anywhere in the world in 48 hours. That’s the kind of infrastructure for emergency response they sought to realize, and to a certain extent they succeeded. They can go to most places in the world relatively quickly, and as long as everything cooperates — all the people and things — they can set up an operation. There’s a similar conception of the “global” in global health, which tends to focus on particular projects and campaigns as opposed to general system building in a given nation state (unlike the older international health). It likewise generally shares MSF’s secular, medical focus on “saving human lives”. This notion of biomedicine as a response to human suffering reveals complex technical and ethical issues, particularly when cast at a global scale.

I should also note that MSF is no longer really a French organization; it became European in the 1980s and has increasingly grown transnational. Indeed the French part is a minority at this point. The dominant language across MSF has increasingly become English, which is also the dominant language of aid, trade etc., often in an asymmetrical way. At the same time most people involved with the group believe strongly in human equality, value diversity and don’t want to mimic colonial empire. So there are several kinds of globalization at work, not all of which neatly line up. That’s anthropologically interesting.

It was a question of being in the right place at the right time. I was brought on to the project after the initial investigators, who were two professors of sociology at UCLA, had developed this idea to study the impact of newborn screening in the clinic. They had learned that newborn screening was in this new phase of development where the state had just rolled out screening tests for a large number of disorders. They were really interested in doing something around the idea of medical uncertainty and this seemed like a perfect target for exploring some of those ideas, because it was really unclear what the impact of screening asymptomatic children for such a large number of disorders was going to be. At the time that this was getting off the ground, I was a graduate student. I was working on my dissertation research and I started out working on the newborn screening project as a research assistant. Over time, one of the investigators got busy with other projects, and I ended up taking on a bigger role, and working more closely with Stefan Timmermans, who co-authored the book with me.